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Recent Changes to the PEHP Preferred
Drug List
The Preferred Drug List includes prescription medications that
have been chosen by PEHP's Pharmacy and Therapeutics Committee -- a
team of local physicians, nurses, and pharmacists -- to be available
at a lower Copayment. The committee chooses medications that provide
the best value based on quality, safety, effectiveness and cost. The
Preferred Drug List is modified periodically with changes based on
recommendations from the committee.
Below are the most recent updates to the Preferred Drug List.
| DRUG NAME |
EFFECTIVE DATE |
ACTION |
COVERAGE |
PREFERRED DRUG LIST RECOMMENDATIONS |
| EVISTA |
1/1/2009 |
DELETION |
TIER 3 |
ALENDRONATE, TAMOXIFEN |
| TRICOR |
1/1/2009 |
DELETION |
TIER 3 |
FENOFIBRATE |
| BAYER TEST STRIP |
1/1/2009 |
DELETION |
TIER 3 |
ACCU-CHEK, ONETOUCH |
| PROVENTIL HFA |
1/1/2009 |
DELETION |
TIER 3 |
PROAIR HFA, XOPENEX HFA |
| LEVAQUIN |
1/1/2009 |
DELETION |
TIER 3 |
AVELOX |
| EXFORGE |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR, MICARDIS AND AMLODIPINE |
| XOPENEX SOLUTION |
1/1/2009 |
DELETION |
TIER 3 |
ALBUTEROL SOLUTION |
| PULMICORT |
1/1/2009 |
DELETION |
TIER 3 |
ASMANEX, FLOVENT, QVAR |
| TEKTURNA |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR, MICARDIS, COZAAR |
| TEKTURNA HCT |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR HCT, MICARDIS HCT, HYZAAR |
| DIOVAN |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR, MICARDIS, COZAAR |
| DIOVAN HCT |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR HCT, MICARDIS HCT, HYZAAR |
| ATACAND |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR, MICARDIS, COZAAR |
| ATACAND HCT |
1/1/2009 |
DELETION |
TIER 3 |
BENICAR HCT, MICARDIS HCT, HYZAAR |
| FOSAMAX D |
1/1/2009 |
DELETION |
TIER 3 |
ALENDRONATE |
| PROTONIX |
1/1/2009 |
ADDITION |
TIER 2 |
|
| PANTOPRAZOLE |
1/1/2009 |
DELETION |
NO COVERAGE |
PROTONIX |
| IMITREX INJ |
1/1/2009 |
DELETION |
TIER 3 |
SUMITRIPTAN |
| ASCENSIA TEST STRIP |
1/2/2009 |
DELETION |
TIER 3 |
ACCU-CHEK, ONETOUCH |
| IMITREX TABLETS |
1/15/2009 |
DELETION |
TIER 3 |
SUMITRIPTAN |
| ZERIT |
1/15/2009 |
DELETION |
TIER 3 |
STAVUDINE |
| RISPERDAL-M |
3/15/2009 |
DELETION |
TIER 3 |
RISPERIDONE ODT |
| AMPHETAMINE MIXED ER |
4/1/2009 |
DELETION |
NO COVERAGE |
ADDERALL XR |
| SIMCOR |
5/1/2009 |
ADDITION |
TIER 2 |
|
| RENVELA |
5/15/2009 |
ADDITION |
TIER 2 |
|
| TOPAMAX |
5/15/2009 |
DELETION |
TIER 3 |
TOPIRAMATE |
| SIMPONI* |
6/1/2009 |
ADDITION |
TIER 4 |
|
| NAMENDA* |
6/15/2009 |
ADDITION |
TIER 2 |
|
| PRISTIQ* |
6/15/2009 |
ADDITION |
TIER 2 |
|
| RETIN-A MICRO* |
7/1/2009 |
DELETION |
TIER 3 |
TRETINOIN |
| AVANDIA |
7/1/2009 |
DELETION |
TIER 3 |
ACTOS |
| AVANDARYL |
7/1/2009 |
DELETION |
TIER 3 |
DUETACT |
| AVANDAMET |
7/1/2009 |
DELETION |
TIER 3 |
ACTOPLUS MET |
| PROTOPIC |
7/1/2009 |
DELETION |
TIER 3 |
ELIDEL |
| FROVA |
7/1/2009 |
DELETION |
TIER 3 |
SUMITRIPTAN, MAXALT, RELPAX |
| AMERGE |
7/1/2009 |
DELETION |
TIER 3 |
SUMITRIPTAN, MAXALT, RELPAX |
| ZOMIG |
7/1/2009 |
DELETION |
TIER 3 |
SUMITRIPTAN, MAXALT, RELPAX |
| NASACORT* |
7/1/2009 |
DELETION |
TIER 3 |
FLUTICASONE, FLUNISOLIDE, NASONEX |
| RHINOCORT* |
7/1/2009 |
DELETION |
TIER 3 |
FLUTICASONE, FLUNISOLIDE, NASONEX |
| VERAMYST* |
7/1/2009 |
DELETION |
TIER 3 |
FLUTICASONE, FLUNISOLIDE, NASONEX |
| NUTROPIN* |
7/1/2009 |
DELETION |
TIER 4 |
HUMATROPE, GENOTROPIN, NORDITROPIN |
| TEV-TROPIN* |
7/1/2009 |
DELETION |
TIER 4 |
HUMATROPE, GENOTROPIN, NORDITROPIN |
| OMNITROPE* |
7/1/2009 |
DELETION |
TIER 4 |
HUMATROPE, GENOTROPIN, NORDITROPIN |
| SAIZEN* |
7/1/2009 |
DELETION |
TIER 4 |
HUMATROPE, GENOTROPIN, NORDITROPIN |
| SEROSTIM* |
7/1/2009 |
DELETION |
TIER 4 |
HUMATROPE, GENOTROPIN, NORDITROPIN |
| CELLCEPT |
7/1/2009 |
DELETION |
TIER 3 |
MYCOPHENOLATE |
| SAVELLA |
7/15/2009 |
ADDITION |
TIER 3 |
LYRICA |
| BYSTOLIC |
7/15/2009 |
ADDITION |
TIER 3 |
ATENOLOL, METOPROLOL |
| TEGRETOL XR |
8/1/2009 |
DELETION |
TIER 3 |
CARBAMAZEPINE XR |
| EXFORGE HCT |
8/1/2009 |
ADDITION |
TIER 3 |
HYDROCHLOROTHIAZIDE, AMLODIPINE, BENICAR |
| TRILIPIX |
8/1/2009 |
ADDITION |
TIER 3 |
FENOFIBRATE |
| RYZOLT ER |
8/1/2009 |
ADDITION |
TIER 3 |
TRAMADOL |
| MOXATAG ER |
8/15/2009 |
DELETION |
NO COVERAGE |
AMOXICILLIN |
| VIMPAT |
8/15/2009 |
ADDITION |
TIER 3 |
ZONISAMIDE, TOPIRAMATE, LAMOTRIGINE |
| URSO, URSO FORTE |
9/1/2009 |
ADDITION |
TIER 3 |
URSODIOL |
| LAMICTAL ODT |
9/1/2009 |
ADDITION |
TIER 3 |
LAMOTRIGINE |
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